A Ramnujan Bose awardee, the author with more than a decade of experience in healthcare operations, projects and Quality, shares his experience, insights and thoughts on challenges, issues and solutions covering the large gamut of healthcare quality and administration. He is a Ramanujan Bose prize winner, NABH assessor, ISO 9001:2008 lead Auditor, IMC RBNQA examiner, faculty at various management colleges and member of various prestigious quality committees. He is the founder of Ekohealth

But as we all know the features adopted by Apple is usually never first in industry. Actually I don't remember apple utilising a feature before anyone else does. It always has been improving upon previously experienced technology.

Whether it's fingerprint security, display resolution, waterproof body, Bluetooth earphones etc were all improved upon and never introduced first in industry. Apple does not have the inherent DNA to take innovative risks specially since jobs is not around. We have all seen how apple without jobs has in history tried to bank solely upon their money minting offerings typically and end up losing.

That is what we are seeing now. Iphone was last introduced by jobs. There is nothing which has been introduced by Apple post jobs which has been hugely successful like the iphone. AirPods, lack of earphone socket, touch bar on mac, discontinuing jobs's favourite MacBook Air 11" have all been rejected by users by and large disappointing them to the core.

The only saving grace recently was dual camera bokeh in 7+ which apple didn't even anticipate that it would sell more,messing up the inventory management. And as analysed above the dual camera was not even first in industry by apple. Many brands have had that offering prior. And the same bokeh job can be easily done be any good cam app (I am waiting for the brilliantly demoed adobe bokeh app)

So what do I don't expect in iphone 10 which could have been worthy of apple's legacy:

1.Contactless Wireless charging as it's not introduced yet by other brands. Apple won't risk this as first comer. Tech still needs early adaptation by risk takers like real entrepreneurs on kickstarter.

2.Seamless edgeless display like the Samsung 8 as industry would ridicule them of copying.

3.TouchID inside display as no one has done that yet. 4.3D face recognition as its not introduced already. Apple wont risk this.

What I do expect in iphone 10:

1.Earphone jack to be back as it was the most ridiculous thing to do. Earphone jack is the most universal electronic component since wall socket. Imagine removing electric wall plugs and sockets and being "courageous" to make all things in house wireless for the whim and fancy of a company.

2.Waterproof to continue.

3.Touch ID to be (on side?) or back but in a more convenient location and make screen ratio bigger.

4.New OS 11 which will have battery improvement system & other improvements.

9.A display size bigger than 5.5" as that's in larger demand for apple

10.Dual camera even in 4.7 inch phone as they was saving grace for apple sale recently.

11.All glass body like iphone 4 to make it look different branding wise. Maybe even a sapphire glass option. Similarity in design has been biggest name for Apple as people buy apple also for pride of ownership. The loom change due to dual camera in larger phone was also reason for its better sale than the lower size version.

12.New Display material like OLED as that's in trend. 13. Iris scan(Maybe) as its already introduced by few brands & that Governments like India are pushing phone manufacturers to have it for UID.

So that's it folks.

Let's check back in June (or later in September if apple delays its anniversary launch) and I hope apple proves me wrong for the innovation part. My most desired feature is contactless wireless charging as it will greatly improve battery life, and dual camera in 4.7 inch too. It will be a disaster if they discontinue the 4.7 size and not reintroduce earphone jack.

In the meanwhile I'm seriously looking forward for pixel's price to drop as the price point is the only reason holding people from buying a fabulous google product.

Apple iphone sale drop trend will continue till the new phones are announced as only a breakthrough in offering can break the saturation and better features in offering by competition specially since Android OS is now almost at par with iOS.

Woah, what a detailed blog Amit. However sorry to say there are a lot of holes in it specially for the company market cap study as it needs an apple to apple study for retail giants vs export giants.

Also the main reason why prescribing generic will be an issue is government(govt) has not considered the active Vs inactive ingredient portion of the components in the drug as both matter sometimes for efficacy in terms of absorption time etc which has not been touched upon by you as the main issue here.

When we speak of generics it's mostly for core active molecule and the move by govt is based on international best practice to prevent financial moral degradation and to reduce nation's's economic wastage when technically something cheaper can be procured (http://www.health.harvard.edu/blog/generic-drugs-dont-ask-just-tell-201301075766). Imagine the potential to reduce insurance premium costs. United States of America and many developed nations are already considering options to do so.

Also the generic names are long names many times and do not include convenient combinations and that could be an issue.

We are facing this move by the government as it was expected some time due to the huge huge moral degradation which I have seen, researched and experienced during my ekohealth times. That is not a myth. The moral degradation is so rotten that even unaffording poor patients are prescribed unaffordable brands when a cheaper brand/generic is easily available. 80% of all debts in Indian Families are due to healthcare expenses & the major contributor to that expense is medicine.

There may be some rare breed of docs who don't take cuts etc, and a lot of docs genuinely won't know about many upcoming quality pharma firms if the ground marketing reach is inadequate. But the research clearly says the degradation is as high as 99% (forget research, we all know the ground reality. you yourself accepted that many hospitals get high MRP printed on cheap drugs for the high margin sale & don't even give a choice to patients to buy another cheaper drug)

I don't know why doctors are the first ones to react so negatively specially on generic medicines if pricing is not an issue. The haa hoopla just on quality is nothing but the insecurity of losing their commissions and nothing else. I can share studies which show that quality and efficacy don't change with different companies (check citation at the end). Also big pharma firms like ranbaxy do not many times adhere to quality and are fined and even small firms like mankind rise in popularity on word of mouth. So that is a different domain altogether and doctors need not worry about it. Govt and FDA will. I'm not even touching upon the rut in diagnostics domain.

I personally consume all medicines which are cheaper than popular ones. The biggest myth is that generics don't have a brand name is false. All medicines which are retailed at chemists have a brand name as per FDA rules and therefore all medicines are branded. Many times the same big manufacturer like Cipla manufacturers multiple different brands of same molecules at different MRP for different markets for retail and export with different MRPs.

So I feel doctors should be concerned with their fees and not the cuts from the sale of medicines. If quality is a concern, doctors can spend some time reading the efficacy reports, articles or peer review. There are some awesome pharmacovigilance portals which doctors can prescribe to know what brands are better effective based on actual practical use. Doctors will be surprised to know that there is hardly ever any difference among different brands/generics & even most popular brand sometimes has a problem and low cost brands equally never do.

It's time docs stand up with courage and hike their fees to what they deserve/desire and stop hiding behind the cover of some drug myths to show a cleaner face and blame everything on the government policies.

The quality will always remain an issue and the same issue needs to be dealt by govt for all manufactures whether their MRP is low or high, known or unknown brand/generic.

You yourself contradicted yourself by saying some hospitals buy at 300 and sell at 3500 as their own brands. Then why is that acceptable to the same doctors who cry on quality?

I sincerely hope there is a price cap on all medicines to bring a level playing field, so no MRP manipulation can happen. Price cap will bring better efficient process to manufacture and bring in stringent quality checks to prevent wastage & returns/rejections.
I had suggested to the govt to bring in a negative price list where only as exception some medicines are beyond price cap and by default all medicines are price capped. High time this happened to prevent any doctor favouring a particular brand only for sake of commissions.

Time has come to improve our moral compass & stop taking cuts or commissions or gifts or holidays to prescribe a certain medicine. Time has come to engage with patients and give them informed choices so they can buy a brand of medicine they want. Time has come to shed our skin of hypocrisy & accept the fact that only doctors can improve the confidence in the general public which is eroding at a pace we cant even imagine. Time has come to being a 'doctor sahab' we once used to be perceived as. That will go a long way as a great patriotic service for the nation.

Time has come to understand the ground realities of moral degradation which has led to a huge collateral damage unfortunately.

Additional readings:

http://bit.ly/generic1

A widely cited research on how generics and branded drugs have same quality and effectiveness and generics are for obvious malefic reasons being disregarded for monetary reasons.

Monday, February 6, 2017

So today's blog is on perception. Perceptions can be dangerous not just for personal stakes but a mindset if becomes a heard mentality can be harmful for the entire community.

I am an ardent fan of Steve Jobs and his creations at apple. I was surely among the first adopters for Apple products. I remember owning proudly the G4 450 Mac which was an amazing piece of technology in the year 2000. As expected that machine still purrs to life and powers on even today without a hitch. I've never had to take it for repairs ever. I later owned an iphone 4 and iPad and a MacBook Air in its initial launch. Those too never had any problems ever. There were eager customer waiting to buy these used beauties.
But then I just realised that every apple product I've bought since 2011 has needed repairs. Fortunately most of them were in warranty but still. I never had that issue with a product from HP or Nokia or blackberry etc. I now remember getting my iphone 5, 6 replaced a couple of times, MacBook Air components and Imac repaired or replaced and so on and so forth. All these apple products bought coincidentally in the last few years. The problem worsens when the warranty is over and just to have a look or diagnostics the service centres (atleast in India) charge large fees.
No doubt that apple has highly superior products (till the time it breaks down) but these frequent breakdowns brings the skeptic in me. I also realised Apple has highest number of repair extension programs for one problem or the other (for those who own apple products please do check internet under heading "repair extension program" for apple. Most of times your problem would be eligible for free repairs even if out of warranty).

Why am I writing this blog?
Main reason being - a loyal passionate customer can become the biggest hatter of a brand as expectations ran high. It therefore becomes a bigger responsibility of a trusted brand to reach out to its ardent brand ambassadors. This should be a learning for all brands no matter what type of an organisation you are.
A product for which you are always willing to pay more for needs to achieve certain benchmarks of quality which it always stood for.
And I see deteriorating customer service, no care attitude of apple brand lately with hundreds of community forum issues unresolved and no significant patches for talked about complains in various updates.
No doubt apple products are superior in experiential point of view for UI and feel, however (as per trends now) till the time repairs are needed.
I'm not saying products are infailable. But then apple did not become a cult for no reason. And I fear that cult ship fading and disappearing over the horizon of better competing brands and products on the envil.
I'm not even saying that apple does not respond to your grievance. It does and it takes a lot of effort and followup from the customer's side. But then it's more of a polite courstesy extended by apple than a genuine attempt to resolve an issue quickly and for good (for example my iOS spotlight issue is unresolved by Apple since more than a year)
This is the first time I'm considering switching to a Windows or android product for obvious reasons of meeting a certain expectation and not getting swayed by the cult and getting disappointed all over again.